Letters, calls and emails: PCT-led practices offer care, not QoF

I was surprised to read this week's headline 'PCT-run practices have 14% lower quality scores' for two reasons.

I am surprised that the difference is so small, and I am surprised by the apparent lack of understanding of most of commentators of what this means and the reasons for it.

I used to be a GMS partner and, although I work shorter hours, for a lot less money pro rata, I give as good or better-quality care as when I was a partner. A lack of available partnerships means these jobs are often filled by experienced, well-trained and motivated GPs, not the dregs as is implied.

The main issue is that there is no reason for PCT practices to spend time on the quality framework that they could spend on patient care. One of the nice things about working in a PCT practice is that you can put patient need first, rather than obsessing about how to make money out of them.

The quality framework is about income generation, not quality care. Many aspects of good care, like whether the patient feels listened to and involved in decision making (including deciding not to follow guidelines), are virtually ignored in the framework, as are many disease areas such as chronic pain, rheumatoid arthritis and chronic 'minor' mental health problems.

PCT-led practices do not benefit financially from increased quality scores as the minimum money is put into the practices to cover salaries and basic costs (at least in my PCT). The GPs do not receive performance-related pay.

Do you think a patient benefits from being 'exception reported', or put on a mental health register, as long as they are getting the right care?

The surprising thing is that we are only 14 per cent behind because we have absolutely no incentive to do much of the quality framework work which really doesn't benefit patients. It is naive in the extreme to think that the quality framework really represents good care; it merely represents what is easily recorded and counted.

The other issue is that it is usually poorly performing practices with huge healthcare needs that are taken on by PCTs. This is not a problem that can be instantly turned around, it takes years of work and patient education.